Characteristics and Outcomes of Patients Presenting to Rural or Urban Emergency Departments with COVID‐19

Abstract

BackgroundThe Coronavirus disease 2019 pandemic placed unprecedented strain on healthcare workers and hospital systems. While healthcare institutions across the nation all faced high census numbers, hospitals in rural settings are often burdened with less resources than their urban counterparts. Therefore, we hypothesized that receiving care in rural settings would be associated with poorer clinical outcomes.ObjectiveTo compare the characteristics and outcomes of patients with SARS‐CoV‐2 presenting to urban and rural emergency departments in the American southwest.MethodsA multisite retrospective chart review of patients admitted to inpatient care due SARS‐CoV‐2 infection from March 1st, 2020 through January 31st, 2021 was conducted at three participating hospitals. ed data included patient demographics, intake laboratory values, and patient outcomes. Analysis was conducted using descriptive statistics, the Pearson chi‐square for categorical data, the Mann‐Whitney U test for continuous data, and Kaplan‐Myer for disease progression.ResultsA total of 489 patients with confirmed SARS‐CoV‐2 infection via nasopharyngeal sample were included in the analysis with 57.1% (279/489) presenting to an urban emergency department. Patients admitted in the rural and urban setting showed similar demographics in regard to age (p=0.710), sex (p=0.312), and majority/minority status (p=0.062). Upon presentation, patients in rural settings were more likely to have critically low white blood cell counts (p<0.001), abnormally high hematocrit (p=0.001), and abnormally high aspartate aminotransferase levels (p<0.001) than their urban counterparts. Following admission, urban patients were 2.53 times more likely than rural patients to be transferred to critical care (p<0.001) with the transfer contributing to a reduced hospitalization length of 2.7 days in the urban setting (p=0.002). Rural patients unable to transfer to critical care were 4.95 times more likely to expire than urban patients (p=0.014).ConclusionPatients receiving care for SARS‐CoV‐2 infection in the rural setting often present with more severe clinical profiles and are more likely to experience negative outcomes than their urban counterparts. Rural hospitals should attempt to reduce this discrepancy by developing robust prognostic procedures to minimize critical care bed utilization.